Endoscopic repair of large inguinoscrotal hernias: management of the distal sac to avoid seroma formation
- Hernia : the journal of hernias and abdominal wall surgery
- Published almost 8 years ago
BACKGROUND: The best approaches to repairing large inguinoscrotal hernias and handling of the distal sac are still debated. Complete dissection of a distal sac which extends deep into the scrotum carries a risk of orchitis and damage to the cord structures. However, failure to deal with the distal sac often results in the formation of a large and bothersome seroma or pseudohydrocele. We describe a technique for managing large distal sacs to avoid clinically important seromas when repairing large inguinoscrotal hernias, using the enhanced view totally extraperitoneal (e-TEP) endoscopic technique. METHODS: From October 2010 to November 2011, 94 consecutive elective hernia repairs were performed using the e-TEP technique. Six of these patients had large inguinoscrotal hernias, defined as hernias extending deep into the scrotum with a distal sac not amenable to dissection. In these six patients, we managed the distal sac by pulling it out of the scrotum and fixing it high and laterally to the posterior inguinal wall. We prospectively followed these patients and examined them at 8 days and 1 and 3 months postoperatively, looking specifically for signs or symptoms of seroma. Ultrasonography was performed at each follow-up visit. RESULTS: Only one of the patients had developed a seroma by the eighth postoperative day. The seroma was drained and did not recur or produce symptoms during the following 3 months. There were no major complications or early recurrences in the series. CONCLUSIONS: Patients with large inguinoscrotal hernias and sacs extending deep into the scrotum can benefit from reduction and fixation of the distal sac high and laterally to the posterior inguinal wall. This technique lowers the risk of developing clinically significant seroma.
In pterional craniotomy, fixation plates cause artifacts on postoperative radiological images; furthermore, they often disfigure the scalp in hairless areas. The authors describe a simple technique to fix a cranial bone flap with only a single plate underneath the temporalis muscle in an area with hair, rather than using a plate in a hairless area. The key to this technique is to cut the anterior site of the bone flap at alternate angles on the cut surface. Interdigitation between the bone flap and skull enables single-plate fixation in the area with hair, which reduces artifacts on postoperative radiological images and provides excellent postoperative cosmetic results.
Plant growth-promoting rhizobacteria (PGPR) may provide a biological alternative to fix atmospheric N2 and delay N remobilisation in maize plant to increase crop yield, based on an understanding that plant-N remobilisation is directly correlated to its plant senescence. Thus, four PGPR strains were selected from a series of bacterial strains isolated from maize roots at two locations in Malaysia. The PGPR strains were screened in vitro for their biochemical plant growth-promoting (PGP) abilities and plant growth promotion assays. These strains were identified as Klebsiella sp. Br1, Klebsiella pneumoniae Fr1, Bacillus pumilus S1r1 and Acinetobacter sp. S3r2 and a reference strain used was Bacillus subtilis UPMB10. All the PGPR strains were tested positive for N2 fixation, phosphate solubilisation and auxin production by in vitro tests. In a greenhouse experiment with reduced fertiliser-N input (a third of recommended fertiliser-N rate), the N2 fixation abilities of PGPR in association with maize were determined by 15N isotope dilution technique at two harvests, namely, prior to anthesis (D50) and ear harvest (D65). The results indicated that dry biomass of top, root and ear, total N content and bacterial colonisations in non-rhizosphere, rhizosphere and endosphere of maize roots were influenced by PGPR inoculation. In particular, the plants inoculated with B. pumilus S1r1 generally outperformed those with the other treatments. They produced the highest N2 fixing capacity of 30.5% (262 mg N2 fixed plant-1) and 25.5% (304 mg N2 fixed plant-1) of the total N requirement of maize top at D50 and D65, respectively. N remobilisation and plant senescence in maize were delayed by PGPR inoculation, which is an indicative of greater grain production. This is indicated by significant interactions between PGPR strains and time of harvests for parameters on N uptake and at. % 15Ne of tassel. The phenomenon is also supported by the lower N content in tassels of maize treated with PGPR, namely, B. pumilus S1r1, K. pneumoniae Fr1, B. subtilis UPMB10 and Acinetobacter sp. S3r2 at D65 harvest. This study provides evidence that PGPR inoculation, namely, B. pumilus S1r1 can biologically fix atmospheric N2 and provide an alternative technique, besides plant breeding, to delay N remobilisation in maize plant for higher ear yield (up to 30.9%) with reduced fertiliser-N input.
The definition of anti-HLA antibody profile in highly sensitized patients on a waiting list is crucial when virtual crossmatch is used in organ allocation systems, but also when used to identify the true deleterious anti-HLA antibodies. Here we propose different levels of risk based on the results of anti-HLA antibody testing in neat serum (N) and after sera dilution (DIL) and C1q test in 18 highly sensitized patients. This group was heterogeneous in terms of anti-HLA antibody titers and their ability to fix complement. After dilution, 15 out of 18 patients (83.3%) showed a reduction of positive bead counts whereas 4 patients showed a prozone effect and complement fixation was demonstrated. The high dilution of sera and ascertaining the complement fixation allow the accurate definition of risk anti-HLA antibody profiles in highly sensitized patients, as demonstrated in 5 of the sensitized patients who were transplanted.
Nail bed injuries are common in children, with nail bed damage accounting for 15% to 24% of fingertip injuries. Our objective was to see whether medical adhesives, the cyanoacrylates including Histoacryl and Dermabond, could be used to fix nail bed lacerations as opposed to doing a primary repair with sutures, thus potentially being a quicker method for repair in the emergency department for these injuries.
Video filmed by a camera mounted on the head of a Northern Goshawk (Accipiter gentilis) was used to study how the raptor used visual guidance to pursue prey and land on perches. A combination of novel image analysis methods and numerical simulations of mathematical pursuit models was used to determine the goshawk’s pursuit strategy. The goshawk flew to intercept targets by fixing the prey at a constant visual angle, using classical pursuit for stationary prey, lures or perches, and usually using constant absolute target direction (CATD) for moving prey. Visual fixation was better maintained along the horizontal than vertical direction. In some cases, we observed oscillations in the visual fix on the prey, suggesting that the goshawk used finite-feedback steering. Video filmed from the ground gave similar results. In most cases, it showed goshawks intercepting prey using a trajectory consistent with CATD, then turning rapidly to attack by classical pursuit; in a few cases, it showed them using curving non-CATD trajectories. Analysis of the prey’s evasive tactics indicated that only sharp sideways turns caused the goshawk to lose visual fixation on the prey, supporting a sensory basis for the surprising frequency and effectiveness of this tactic found by previous studies. The dynamics of the prey’s looming image also suggested that the goshawk used a tau-based interception strategy. We interpret these results in the context of a concise review of pursuit-evasion in biology, and conjecture that some prey deimatic ‘startle’ displays may exploit tau-based interception.
To evaluate the biomechanical and clinical results of modified separate vertical wiring technique (SVW) for inferior pole patellar fracture repair we conducted a finite element biomechanical study using 2 fixation methods and evaluated a clinical series of eleven patients. The modified SVW technique was an effective, safe and simple method that can provide stable fixation for early exercise with excellent functional results in fixing inferior pole patella fractures.
Comminuted patella fractures are uncommon and difficult fractures to manage. Multiple treatment modalities have been suggested, with little clinical data to support practice. Recent biomechanical and technical investigations have described successful plate fixation of comminuted patella fractures. The purpose of this study was to evaluate radiographic, clinical and functional outcome of comminuted patella fractures treated with a fixed angle locking plates. We believe stable fixation, which results in successful fracture union and functional recovery, can be achieved with this technique.
We evaluated a new concept for treating pupillary capture of the intraocular lens (IOL) following intrascleral fixation of the IOL. Pupillary capture of the IOL is a common postoperative complication that occurs after suturing and intrascleral fixation of the IOL. In such cases, blunt trauma is often related to zonular dialysis, iris retraction, iridodonesis, and angle recession. Several methods such as barricading by suturing, pupilloplasty, and pars plana fixation are reported to prevent pupillary capture. Although effective, none of these techniques fix iris-malposition and angle recession. We considered that repairing angle recession could correct the iris position and prevent pupillary capture recurrence.
Layered double hydroxides (LDH) of Mg/Al are anion exchangers that are candidate materials for phosphate (PO4) recovery and recycling from waste streams. However, PO4recycling in agriculture might be limited by incomplete desorption of PO4from the minerals. This study was set up to identify the factors explaining irreversible PO4sorption (“fixation”) on LDHs by comparing the isotopic exchangeability (33PO4) with the PO4desorption from LDH materials and from boehmite as a P fixing reference mineral. Six different Mg-Al LDH materials were synthesized, by varying the synthesis pH and exposing obtained materials to hydrothermal (HT) treatment. Phase pure LDH materials were obtained from syntheses at pH 10 and 12, while at pH 8 Al-rich phase impurities such as a boehmite or gibbsite were formed. Crystallite size increased significantly during HT treatment. The LDHs were first loaded with PO4prior to33PO4isotopic exchange (0-20 days, 1 mM NaHCO3) or PO4desorption (0-20 days, NaHCO3concentrations increasing from 0 to 20 mM). The isotopic PO4exchangeability was 85-95% of total PO4after 72 h in the phase pure LDHs with intercalated PO4whereas this value was 40-54% in the presence of Al-rich phase impurities in non-HT treated materials and in boehmite. In contrast, the maximally desorbed PO4fractions were only 55-63% for the phase pure LDHs, indicating that not all of the isotopically exchangeable PO4can be desorbed. Samples at different stages of desorption (different initial NaHCO3concentrations) were subjected to isotopic exchange after desorption. In the LDHs with PO4intercalation, PO4was increasingly less isotopically exchangeable as the initial NaHCO3concentrations increased, while this trend was not observed for samples without intercalated PO4. This suggests that PO4becomes increasingly less accessible for isotopic exchange as the fraction binding sites occupied with HCO3-increases. The interlayer outward diffusion of PO4might be increasingly rate limited upon H2PO4-/HCO3-exchange, which explains the PO4fixation in LDHs.